If the insurer disputes liability for your claim there is help available.
Where the insurer disputes liability for your workers compensation claim they will advise you of their reason(s) in writing (this is called a decision notice) and provide information on the next steps available to you.
Examples of when disputes can happen include:
- the insurer does not consider the person making the claim to be a ‘worker’ (under the legislation)
- the insurer considers that employment was not a substantial contributing factor to the injury
- it was not 'reasonably necessary' to have the medical treatment or other claim-related expenses.
When disputes happen there is help available to have it resolved.
Request a review by the insurer
You may contact the insurer and request they review the decision.
When requesting a review, include any additional information you think is relevant to help the insurer review the decision.
The insurer must respond to you in writing within 14 days of receiving the request for a review. The insurer will either decide to overturn or modify the original decision or maintain the decision.
If the insurer fails to attach all relevant documents to the decision notice, then they must correct the decision notice(s) as soon as they become aware.
You (the worker) can contact the Workers Compensation Independent Review Office (WIRO) if you are dissatisfied at any stage during this process.
WIRO is an independent statutory office with a variety of roles, including helping find solutions to disputes by contacting the insurer on your behalf.
Where disputes cannot be resolved, the WIRO will advise you and your representative to get advice from a lawyer approved under the Independent Legal Assistance and Review Service (ILARS). The lawyer will review your case and may make an application to WIRO to see if funding is available to help resolve the dispute in the Workers Compensation Commission (WCC).
For more information on how WIRO can help:
Apply to the Workers Compensation Commission to resolve the dispute
If you do not wish to seek a review by the insurer or are not satisfied with the insurer's decision after a review, you can lodge an application to resolve the dispute at the Workers Compensation Commission (WCC). You do not need legal representation to make an application with the WCC.
The WCC is an independent tribunal that helps resolve workers compensation disputes between injured workers, employers and/or insurers.
The kind of disputes they resolve include:
- work capacity decisions
- weekly payments and compensation
- medical, hospital and related expenses
- permanent impairment compensation
- compensation for damage to personal property
- compensation for domestic assistance.
The process for resolving your dispute depends on the type of matter that is in dispute.
For most matters (e.g. where compensation, medical expenses or liability is disputed) the WCC will appoint an arbitrator. Arbitrators are independent decision makers experienced in the workers compensation system and in dispute resolution.
For more information you can visit the WCC website or call 1300 368 040.